Transcript Cardiac Cath and Angiocardiography

Cardiac Cath and
Angiocardiography
SPRING 2011
Catherization Studies
and Procedures
•Adults
•Children
Basic Diagnostic Studies of the
Vascular System for Adults
Cath of the LT side of the heart:
ADULTS
• Catheter introduced into
the radial, brachial or
femoral artery to the
ascending aorta
• Aortic root angio is
performed to document
competence of the aortic
valve
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Aorta Root Angiography
• Normal means backward
flow of the contrast media
into the LT ventricle
during injection
• Atrial oximetry and blood
pressure within aorta are
measured
• Then advanced into the
LT ventricle
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LT Ventriculography
• Provides info on valvular
competence
• Interventricular septal
integrity
• Efficiency of the pumping
action of LT ventricle
• Pressure measurements
are made
• When systolic (LT
ventricle) does not match
systolic (aorta)- could
mean aortic stenosis
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Coronary Angiography
• Allows the extent of intracoronary stenosis to be
evaluated
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Coronary Angiography
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Coronary Angiography
LT coronary
artery
Normal LT coronary Artery
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Cath of the RT side
of the heart:
ADULTS
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Cath of the RT side of the heart:
ADULTS
• Pressure measurements
– Used to determine valvular heart disease
– Congestive heart failure
– Pulmonary hypertension
– Cardiomyopathies
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Exercise Hemodynamics
• For evaluation of valvular disease
– When fatigue and dyspnea are present
• Simultaneous catherization is done and
pressure measurements of RT & LT heart is
taken
– At rest
– With exertion
• Catheter is placed in:
– An artery (femoral or brachial)
– Vein (femoral or basilic)
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Basic Diagnostic Studies of the
Vascular System for Children
• For evaluation of specific hemodynamic
data
– Selected aspects of cardiac function
– Congenital heart defects
• Methods are different according to age
and size of the heart
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Advanced Diagnostic Studies of the
Vascular System for Adults &
Children
• Biopsy catheter with
bioptome tip is
inserted into jugular
or femoral vein into
RT ventricle
• Jaws are opened and
many biopsies are
taken
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Bioptome Biopsies
• Used to monitor
cardiac transplants for
tissue rejection
• And to differentiate
between various
types of
cardiomyopathies
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Studies of the Conduction System
for Adults & Children
Mulipolar catheters are inserted in
•High RT atrium near sinus node
•Atrioventricular apex
•Coronary sinus
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Studies of the Conduction System
for Adults & Children
• Sometimes 3 introducer sheaths are
placed in one vein
– Femoral
– Internal jugular vein
– Subclavian vein
• Cathodes serve a dual function
– Record electrical signals
– Pace the heart
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Interventional Procedures of the
Vascular System: Adults
• Percutaneous Transluminal Coronary
Angioplasty (PTCA)
– Also known as balloon angioplasty
– Employs balloon to dilate the coronary artery
stenosis
• The placement of the catheter is placed
much in the same way as standard
coronary angiography
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PTCA cont
• Special steerable PTCA
guidewire is used.
• Guidewire is advanced to
stenotic area through the
balloon catheter
• Balloon is pushed
through to the stenotic
area
• Balloon is inflated and
compresses fatty
deposits
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PTCA cont
• Followed by
arteriography to make
sure it blood is flowing
• This may be done
repeated times to
assure maximum
dilatation
• Restenosis occurs in
30-50% of patients
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PTCA
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PTCA with Stent placement
• Similar to PTCA alone
except a stent is
placed
• Restenosis is lower
for pt’s who do this
rather than
conventional
angioplasty alone
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PTCA with Stenting
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PTCA with Stent Placement
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• Atherectomy devices
remove the fatty deposit
or thrombus material
within artery
Atherectomy
• Directional coronary
atherectomy devices
having a specialized
cutting device to shave
out the plaque
• There is a special nose
cone that collect the free
floating particles
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Percutaneous transluminal
coronary rotational atherectomy
• The tip is a football shape
and is embedded with
diamond particles
• Special torque guidewire
between 160,000200,000 rpm
• The plaque is pulverized
into particles the size of
RBC’s and removed by
the reticuloendothial
system
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Interventional Procedures of the
Vascular System: Children
• Balloon Septostomy to
enlarge a patent foramen
ovale or preexisting atrial
septal defect
• This allows mixing of RT
and LT blood
– Resulting in improved
arterial oxygenation
• Balloon is passed through
atrial septal opening into the
LT atrium, inflated with
contrast and pulled back
through the orifice
– Causes septum to tear
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Balloon Septostomy with
Transeptal System Approach
• When there is not a
preexisting hole in the
atrial septum
– Transeptal approach is
used
– Catheter with knife is
employed into LT atrium
blade is opened and pulled
back through RT atrium
– Then balloon septostomy
may be performed to open
the hole more
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Interventional Procedures of the
Conduction System: Adults &
Children
• Antiarrhythmic
devices
– Pacemakers
– Implantable
cardioverter
defibrillators
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CXR with Pacemaker
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Post Catheterization Care
• Firm pressure is applied to puncture site for 1530 minutes
• Wound sites are cleaned and dressed
• The patient will be observed in recovery for 4-8
hours
• The insertion site will be checked frequently for
signs of bleeding.
• Medications and discharge instructions are
given
• Lots of fluid should be taken in
• Vital signs should be monitored for 24 hours
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Cardiac Catheterization
Trends
Trends
• Vascular brachytherapy- technique where
radiation is delivered to an area of a
previously stented artery using
endovascular techniques
• Drug eluting stents- drug coated stents
used for treatment of CAD to reduce
restenosis
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MRI
• Is becoming more sophisticated and
having greater detail and resolution
• Allows for is to be used more often for the
cardiovascular system
• MRA is now able to assess anomalies in
the coronary arteries
– And identify calcifications in the coronary
arteries and bypass grafts
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Electron Beam CT
• Can detect heart disease at it earliest and
most treatable stages
– Measures the amount of coronary calcium,
• Electron Beam angiography is a simple
and noninvasive technique that uses IV
contrast media injection
– Effective for visualization of great vessels,
carotid arteries and peripheral vasculature
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